Phase II AZD9291 Open Label Study in NSCLC After Previous EGFR TKI Therapy in EGFR and T790M Mutation Positive Tumours

This is a phase II, open label, single arm study assessing the safety and efficacy of AZD9291
(80 mg, orally, once daily) in patients with a confirmed diagnosis of Epidermal Growth Factor
Receptor mutation positive and T790M mutation positive NSCLC,who have progressed following
prior therapy with an approved Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor
(EGFR-TKI) agent. Patients must agree to provide a biopsy for central confirmation of T790M
mutation status following confirmed disease progression on the most recent treatment regimen.
The primary objective of the study is to assess the efficacy of AZD9291 by assessment of
Objective Response Rate according to RECIST 1.1 by an Independent Central Review.

Inclusion:

- Aged at least 18 years. Japan patients aged at least 20 years.

- Locally advanced/metastatic NSCLC not amenable to curative surgery or radiotherapy

- Radiological documentation of disease progression:

following 1st line EGFR TKI treatment but who have not received further treatment OR
following prior therapy with an EGFR TKI and a platinum-based doublet chemotherapy.
Patients who received prior EGFR TKI and platinum-based doublet chemotherapy may have also
received additional lines of treatment. All patients must have documented radiological
progression on the last treatment administered prior to enrolling in the study.

- Disease progression following 1st line EGFR TKI treatment or following prior EGFR TKI
and platinum-containing doublet chemotherapy.

- Confirmation that the tumour harbours an EGFR mutation known to be associated with
EGFR TKI sensitivity (including G719X, exon 19 deletion, L858R, L861Q). Patients must
have central confirmation of tumour T790M mutation positive status from a biopsy
sample taken after confirmation of disease progression on the most recent treatment
regimen.

- World Health Organisation (WHO) performance status 0-1 with no deterioration over the
previous 2 weeks and a minimum life expectancy of 12 weeks.

- At least one lesion, not previously irradiated and not chosen for biopsy during the
study screening period, that can be accurately measured at baseline as ≥ 10mm in the
longest diameter (except lymph nodes which must have short axis ≥ 15mm) with
computerised tomography (CT) or magnetic resonance imaging (MRI) which is suitable for
accurate repeated measurements.

- Females of child-bearing potential using contraception; negative pregnancy test.

Exclusion:

- Treatment with an EGFR-TKI within 8 days of study entry; any cytotoxic chemotherapy,
investigational agents or other anticancer drugs within 14 days of study entry;
previous treatment with AZD9291 (or 3rd generation TKIs); major surgery within 4
weeks; radiotherapy treatment to more than 30% of the bone marrow or with a wide field
of radiation within 4 weeks; current treatment with potent inhibitors of CYP2C8 and
potent inhibitors/inducers of CYP3A4.

- Unresolved toxicities from prior therapy.

- Unstable spinal cord compression/brain metastases.

- Severe/uncontrolled systemic diseases, including uncontrolled hypertension, bleeding
diatheses or infection.

- Refractory nausea/vomiting, chronic gastrointestinal diseases or bowel resection.

- Cardiac disease.

- Past history of ILD, drug-induced ILD, radiation pneumonitis which required steroid
treatment, or any evidence of clinically active interstitial lung disease.

- Inadequate bone marrow reserve or organ function.